The subcutaneous tissue was opened with cautery (blend current) using quick sketching strokes to avoid thermal injury. The tissue is opened carefully to the level of Scarpa's fascia to expose but not injure the superficial epigastric vessels that invariably cross the middle of the incision.

The superficial epigastric vessels were identified, isolated, ligated and divided. It is easy to miss these vessels when using cautery. The vessels are elastic and retract into the fat where they can later start bleeding and cause a hematoma.